NS Birth Certificate Application v4 - VitalCertificates.ca

Nova Scotia Birth Certificate Application
Pease Note: You cannot use this application and must contact Nova Scotia Vital Statistics directly at (902) 424-4381 if you are applying
for a child and you are not a parent listed on the birth registration or a legal guardian with guardianship papers.
If Adopted: Please provide the adoptive parents’ names and the current legal name of the adoptee.
Step 1 - Contact Information - Person applying for certificate
Name: __________________________________________________ Firm/Organization: ______________________________________
Applicant
Complete only if certificate(s) to be delivered here.
Telephone Number:(_____) ___________________Extension: _____ Daytime Number:(_____) ___________________Extension: _____
Mailing Address: ________________________________________________________ Apt.: ___________ Buzzer Code:____________
City: _________________________ Prov./State: ________________ Country: _________________ Postal/Zip Code:________________
Email Address: ___________________________________________________________________________________________________
Step 2 - Birth Details of Subject - Person named on certificate
You must enter as much information as possible for the subject and the parents. Missing or incorrect information may delay your application.
Reason Certificate Required: ________________________________________________________________________________________
Please specify reason . Example: Lost, personal records, passport application, damaged etc...
Subject Name:_______________________ ______________________ _______________________ Male Female
First Middle *Last
*Use the subject’s last name at birth or adoptive name unless there has been a legal name change.
Date of Birth: _______________________ _________ _________
Month Day Year City/Town
Father/Co-Parent Name: _____________________________ _____________________________
Certificates take approximately 4 - 6 weeks to be processed and delivered. Delivery times are average delivery times and cannot be guaranteed.
All taxes and shipping included.
____ Qty. - *Individual Information Birth Certificate - $80.00 each
____ Qty. - ***Certified Copy of Birth Registration - $85.00 each
Place of Birth: _______________________________, Nova Scotia
______________________________
First Middle - must provide full name if known *Last - at birth
*If the father was adopted, enter adopted name
Place of Birth: ____________________________________ _____________________________
City/Town Province/State Country
Mother’s Name: ___________________________________ _____________________________
______________________________
______________________________
First Middle - must provide full name if known *Last - maiden name
*If the mother was adopted, enter adopted name
Place of Birth: ____________________________________ _____________________________ ______________________________
City/Town Province/State Country
Newborns: Birth registration must be complete (about 4 weeks) before certificate applications will be processed. Certificate applications will be held until
registration is complete.
Step 3 - Payment Information - Select certificate type and payment method
____ Qty. - **Family Information Birth Certificate - $85.00 each
* Individual Information Birth Certificate: Contains individual’s name, date of birth, place of birth and sex.
** Family Information Birth Certificate: Contains individual’s name, date of birth, place of birth, sex, parent(s) name(s) and their birthplace(s).
*** Certified Copy of Birth Registration: This a photocopy of the actual birth registration as filled in by the parents. The photocopy is certified as a true copy of the original. Not for use as identification.
Credit Card Type: (or) Phone me for credit card details. Phone No. (_____) _________________
Credit Card Number: _____________________________________________ Exp. Date: ___________
Name of Cardholder: _____________________________________________ Cardholder Email:__________________________________
Type/Print Name
Signature: ______________________________________________________ Date: _______________
Charge will appear as “Express Legal” on credit card statement.
If paying by money order or certified cheque please mail the completed application along with your payment.
Any application received with a personal cheque will be held until such time as the cheque clears, typically 7 to 10 days.
Cheques and money orders must be made payable to “Express Legal”.

Step 4 - Provide Authorization
Nova Scotia Birth Certificate Authorization
By signing this authorization, you are permitting Express Legal to request your certificate of birth.
Your certificate will be sent to you directly from the government agency. A completed and signed
authorization must be provided.
Please check the appropriate box:
I am the person who is the subject of the certificate;
I am a parent of the person who is subject to the certificate;
I am a guardian of the person whose birth is registered (provide a copy of guardianship papers).
I, ___________________________________, hereby authorize Express Legal to request one or more
Print / Type name of applicant
Certificates of Birth from the Nova Scotia Vital Statistics Agency on my behalf. I further authorize Express
Legal to correspond in writing or orally with the Nova Scotia Vital Statistics Agency with respect to this
application.
Date:
_______________ / _________ / _________
Month Day Year
Signature:
______________________________
Applicant - Signature must be provided
Step 5 - Submit Application
Please return your completed application and
authorization to us by one of the following methods:
Toll-Free Fax: 1.866.265.6300
or Scan & Email: novascotia@expresslegal.ca
or Regular Mail
ExpressLegal, 79-622 Front Street, Nelson, BC V1L 4B7
Toll-Free Phone: 1.866.828.9680
IMPORTANT NOTE: Although you can fill out the application online, you cannot save or email it.
Please type, print and sign the application then fax, scan and email or mail your application to us.
Applications are processed upon receipt. We cannot change or cancel applications once received.